Portable ultrasonography in mass casualty incidents: The CAVEAT examination

World Journal of Orthopedics

Volumn 1, Issue 1, 2010, Pages 10-19

  Stawicki, Stanislaw Peter ^a   Howard, James M ^a   Pryor, John P ^b   Bahner, David P ^a   Whitmill, Melissa L ^a   Dean, Anthony J ^b  

^a THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

Chest, abdomen, vena cava, and extremities for acute triage; Disaster; Field triage; Focused assessment with sonography in trauma; Mass casualty incident; Pre hospital care; Ultrasonography

Indexed keywords

EID: 84880532489     PISSN: None     EISSN: 22185836     Source Type: Journal    
DOI: 10.5312/wjo.v1.i1.10     Document Type: Article

References (113)

1. Kendall JL, Hoffenberg SR, Smith RS. History of emergency and critical care ultrasound: the evolution of a new imaging paradigm. Crit Care Med 2007; 35: S126-S130.
2. Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J 2004; 21: e5.
3. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma 2004; 57: 288-295.
4. Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, Dean AJ. Intensivist use of handcarried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Surg 2009; 209: 55-61.
5. Carr BG, Dean AJ, Everett WW, Ku BS, Mark DG, Okusanya O, Horan AD, Gracias VH. Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma 2007; 63: 495-500; discussion 500-502.
6. Einav S, Aharonson-Daniel L, Weissman C, Freund HR, Peleg K. In-hospital resource utilization during multiple casualty incidents. Ann Surg 2006; 243: 533-540.
7. Bremer R. Policy development in disaster preparedness and management: lessons learned from the January 2001 earthquake in Gujarat, India. Prehosp Disaster Med 2003; 18: 372-384.
8. Kendall JL, Blaivas M, Hoffenberg S, Fox JC. History of emergency ultrasound. J Ultrasound Med 2004; 23: 1130-1133; author reply 1133-1135.
9. Melanson SW, McCarthy J, Stromski CJ, Kostenbader J, Heller M. Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp Emerg Care 2001; 5: 399-402.
10. Stinger H, Rush R. The Army forward surgical team: update and lessons learned, 1997-2004. Mil Med 2006; 171: 269-272.
11. Sosna J, Sella T, Shaham D, Shapira SC, Rivkind A, Bloom AI, Libson E. Facing the new threats of terrorism: radiologists' perspectives based on experience in Israel. Radiology 2005; 237: 28-36.
12. Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, Marzi I. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006; 93: 238-242.
13. Lapostolle F, Petrovic T, Lenoir G, Catineau J, Galinski M, Metzger J, Chanzy E, Adnet F. Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med 2006; 24: 237-242.
14. Busch M. Portable ultrasound in pre-hospital emergencies: a feasibility study. Acta Anaesthesiol Scand 2006; 50: 754-758.
15. Price EA, Rush LR, Perper JA, Bell MD. Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children. Am J Forensic Med Pathol 2000; 21: 307-310.
16. Tousignant C. Transesophageal echocardiographic assessment in trauma and critical care. Can J Surg 1999; 42: 171-175.
17. Sarkisian AE, Khondkarian RA, Amirbekian NM, Bagdasarian NB, Khojayan RL, Oganesian YT. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma 1991; 31: 247-250.
18. Legome E, Pancu D. Future applications for emergency ultrasound. Emerg Med Clin North Am 2004; 22: 817-827.
19. Nelson BP, Chason K. Use of ultrasound by emergency medical services: a review. Int J Emerg Med 2008; 1: 253-259.
20. Strode CA, Rubal BJ, Gerhardt RT, Bulgrin JR, Boyd SY. Wireless and satellite transmission of prehospital focused abdominal sonography for trauma. Prehosp Emerg Care 2003; 7: 375-379.
21. Sargsyan AE, Hamilton DR, Jones JA, Melton S, Whitson PA, Kirkpatrick AW, Martin D, Dulchavsky SA. FAST at MACH 20: clinical ultrasound aboard the International Space Station. J Trauma 2005; 58: 35-39.
22. Koenig KL, Dinerman N, Kuehl AE. Disaster nomenclature-a functional impact approach: the PICE system. Acad Emerg Med 1996; 3: 723-727.
23. Pryor JP. The 2001 World Trade Center disaster-summary and evaluation of experiences. Int J Disaster Med 2003; 1: 56-68.
24. Bowra J, Forrest-Horder S, Caldwell E, Cox M, D'Amours SK. Validation of nurse-performed FAST ultrasound. Injury 2010; 41: 484-487.
25. Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, Jackson M, Dulchavsky SA. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med 2008; 27: 745-749.
26. Dean AJ, Breyer MJ, Ku BS, Mills AM, Pines JM. Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies. J Emerg Med 2010; 38: 214-220, quiz 220-221.
27. Hoffmann R, Nerlich M, Muggia-Sullam M, Pohlemann T, Wippermann B, Regel G, Tscherne H. Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma 1992; 32: 452-458.
28. Bode PJ, Edwards MJ, Kruit MC, van Vugt AB. Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol 1999; 172: 905-911.
29. Rozycki GS. Surgeon-performed ultrasound: its use in clinical practice. Ann Surg 1998; 228: 16-28.
30. Moore CL. Surgeon-performed ultrasound for pneumothorax in the trauma suite. J Trauma 2004; 57: 681-682.
31. Dulchavsky SA, Henry SE, Moed BR, Diebel LN, Marshburn T, Hamilton DR, Logan J, Kirkpatrick AW, Williams DR. Advanced ultrasonic diagnosis of extremity trauma: the FASTER examination. J Trauma 2002; 53: 28-32.
32. Mariacher-Gehler S, Michel BA. Sonography: a simple way to visualize rib fractures. AJR Am J Roentgenol 1994; 163: 1268.
33. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med 2005; 23: 45-50.
34. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med 2010; 17: 11-17.
35. Burkle FM Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am 2002; 20: 409-436.
36. Blaivas M. Triage in the trauma bay with the focused abdominal sonography for trauma (FAST) examination. J Emerg Med 2001; 21: 41-44.
37. Sztajnkrycer MD, Baez AA, Luke A. FAST ultrasound as an adjunct to triage using the START mass casualty triage system: a preliminary descriptive system. Prehosp Emerg Care 2006; 10: 96-102.
38. Ma OJ, Norvell JG, Subramanian S. Ultrasound applications in mass casualties and extreme environments. Crit Care Med 2007; 35: S275-S279.
39. Mazur SM, Rippey J. Transport and use of point-of-care ultrasound by a disaster medical assistance team. Prehosp Disaster Med 2009; 24: 140-144.
40. Johnson GA, Calkins A. Prehospital triage and communication performance in small mass casualty incidents: a gauge for disaster preparedness. Am J Emerg Med 1999; 17: 148-150.
41. Nocera A, Garner A. An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard. Aust N Z J Surg 1999; 69: 603-608.
42. Nocera A, Garner A. Australian disaster triage: a colour maze in the Tower of Babel. Aust N Z J Surg 1999; 69: 598-602.
43. Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med 1999; 34: 373-383.
44. DeCara JM, Lang RM, Koch R, Bala R, Penzotti J, Spencer KT. The use of small personal ultrasound devices by internists without formal training in echocardiography. Eur J Echocardiogr 2003; 4: 141-147.
45. Osranek M, Bursi F, O'Leary PW, Bruce CJ, Sinak LJ, Chandrasekaran K, Seward JB. Hand-carried ultrasound-guided pericardiocentesis and thoracentesis. J Am Soc Echocardiogr 2003; 16: 480-484.
46. Stawicki SP, ShiroffAM, Hayden GE, Panebianco NL, Kirkpatrick JN, Horan AD, Gracias VH, Dean AJ. Incidental findings on intensivist bedside ultrasonographic (INBU) examinations: Why should we care? OPUS 12 Scientist 2008; 2: 11-14.
47. Stawicki SP, Seamon MJ, Meredith DM, Chovanes J, Paszczuk A, Kim PK, Gracias VH. Transthoracic echocardiography for suspected pulmonary embolism in the intensive care unit: unjustly underused or rightfully ignored? J Clin Ultrasound 2008; 36: 291-302.
48. Stawicki SP, Seamon MJ, Kim PK, Meredith DM, Chovanes J, Schwab CW, Gracias VH. Transthoracic echocardiography for pulmonary embolism in the ICU: finding the "right" findings. J Am Coll Surg 2008; 206: 42-47.
49. Polk JD, Fallon WF Jr. The use of focused assessment with sonography for trauma (FAST) by a prehospital air medical team in the trauma arrest patient. Prehosp Emerg Care 2000; 4: 82-84.
50. Do JR, McManus J, Harrison B. Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: a case report. Prehosp Emerg Care 2006; 10: 502-506.
51. Huffer LL, Bauch TD, Furgerson JL, Bulgrin J, Boyd SY. Feasibility of remote echocardiography with satellite transmission and real-time interpretation to support medical activities in the austere medical environment. J Am Soc Echocardiogr 2004; 17: 670-674.
52. Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Thomas SH, Harris NS. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest 2007; 131: 1013-1018.
53. Conlon RM. The impact of primary ultrasound and ICT on eradicating disease and poverty. Ultrasound 2008; 16: 28-30.
54. Lyon M, Blaivas M, Brannam L. Use of emergency ultrasound in a rural ED with limited radiology services. Am J Emerg Med 2005; 23: 212-214.
55. SonoWorld. New miniature ultrasound system launched in USA. Cited 2010-11-09; 1 screen. Available from: URL: http://www.sonoworld.com/Client/ModuleContent/ModuleContent.aspx?ContentId=2387.
56. Gillman LM, Ball CG, Panebianco N, Al-Kadi A, Kirkpatrick AW. Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma. Scand J Trauma Resusc Emerg Med 2009; 17: 34.
57. Dulchavsky SA, Schwarz KL, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, Campbell MR, Sargysan AE, Hamilton DR. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 2001; 50: 201-205.
58. Kirkpatrick AW, Simons RK, Brown DR, Ng AK, Nicolaou S. Digital hand-held sonography utilised for the focused assessment with sonography for trauma: a pilot study. Ann Acad Med Singapore 2001; 30: 577-581.
59. Brooks AJ, Price V, Simms M, Ward N, Hand CJ. Handheld ultrasound diagnosis of extremity fractures. J R Army Med Corps 2004; 150: 78-80.
60. Kolkebeck TE, Mehta S. The focused assessment of sonography for trauma (FAST) exam in a forward-deployed combat emergency department: a prospective observational study. Ann Emerg Med 2006; 48: S87.
61. Bonnardot L, Rainis R. Store-and-forward telemedicine for doctors working in remote areas. J Telemed Telecare 2009; 15: 1-6.
62. Martin DS, South DA, Garcia KM, Arbeille P. Ultrasound in space. Ultrasound Med Biol 2003; 29: 1-12.
63. Cermack M. Monitoring and telemedicine support in remote environments and in human space flight. Br J Anaesth 2006; 97: 107-114.
64. Popov V, Popov D, Kacar I, Harris RD. The feasibility of real-time transmission of sonographic images from a remote location over low-bandwidth Internet links: a pilot study. AJR Am J Roentgenol 2007; 188: W219-W222.
65. Yanagawa Y, Nishi K, Sakamoto T, Okada Y. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma 2005; 58: 825-829.
66. Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med 2001; 38: 541-548.
67. Anderson PB, Johnson MS, Bartley B. The emergency medical services system response to a commercial airliner incident at the very remote location of Shemya, Alaska. Prehosp Disaster Med 1997; 12: 36-40.
68. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE-a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med 1996; 11: 117-124.
69. Schultz CH, Koenig KL, Noji EK. A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med 1996; 334: 438-444.
70. Noji EK, Kelen GD. Disaster medical services. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. NY: McGraw-Hill, 2004: 27-35.
71. Thomas TL, Hsu EB, Kim HK, Colli S, Arana G, Green GB. The incident command system in disasters: evaluation methods for a hospital-based exercise. Prehosp Disaster Med 2005; 20: 14-23.
72. Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E. Overtriage in trauma-what are the causes? Acta Anaesthesiol Scand 2007; 51: 1178-1183.
73. Sharma BR. Development of pre-hospital trauma-care sys-tem-an overview. Injury 2005; 36: 579-587.
74. Lehmann R, Brounts L, Lesperance K, Eckert M, Casey L, Beekley A, Martin M. A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg 2009; 144: 853-858.
75. Dean AJ, Ku BS, Zeserson EM. The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster. Am J Disaster Med 2007; 2: 249-256.
76. Parker PJ, Adams SA, Williams D, Shepherd A. Forward surgery on Operation Telic-Iraq 2003. J R Army Med Corps 2005; 151: 186-191.
77. Arbeille P, Capri A, Ayoub J, Kieffer V, Georgescu M, Poisson G. Use of a robotic arm to perform remote abdominal telesonography. AJR Am J Roentgenol 2007; 188: W317-W322.
78. Price DD, Wilson SR, Murphy TG. Trauma ultrasound feasibility during helicopter transport. Air Med J 2000; 19: 144-146.
79. Kirkpatrick AW, Hamilton DR, Nicolaou S, Sargsyan AE, Campbell MR, Feiveson A, Dulchavsky SA, Melton S, Beck G, Dawson DL. Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study. J Am Coll Surg 2003; 196: 833-844.
80. Polk JD, Fallon WF Jr, Kovach B, Mancuso C, Stephens M, Malangoni MA. The "Airmedical F.A.S.T." for trauma patients-the initial report of a novel application for sonography. Aviat Space Environ Med 2001; 72: 432-436.
81. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 1997; 29: 312-315; discussion 315-316.
82. Carrillo EH, Schirmer TP, Sideman MJ, Wallace JM, Spain DA. Blunt hemopericardium detected by surgeon-performed sonography. J Trauma 2000; 48: 971-974.
83. Brooks A, Davies B, Smethhurst M, Connolly J. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J 2004; 21: 44-46.
84. Reardon R, Joing S. Hemothorax after a stab wound to the chest, with clear breath sounds and a normal radiograph. Acad Emerg Med 2006; 13: 786.
85. Tiling T, Boulion B, Schmid A, Schweins M, Steffens H. Ultrasound in blunt abdominopelvic trauma. In: Border JR, Allgower M, Hanson ST, Ruedi TP, eds. Blunt Multiple Trauma: Comprehensive Pathophysiology and Care. New York: Marcel Dekker, 1990: 415-433.
86. Goldberg BB, Clearfield HR, Goodman GA, Morales JO. Ultrasonic determination of ascites. Arch Intern Med 1973; 131: 217-220.
87. Huang MS, Liu M, Wu JK, Shih HC, Ko TJ, Lee CH. Ultrasonography for the evaluation of hemoperitoneum during resuscitation: a simple scoring system. J Trauma 1994; 36: 173-177.
88. McKenney KL, McKenney MG, Cohn SM, Compton R, Nunez DB, Dolich M, Namias N. Hemoperitoneum score helps determine need for therapeutic laparotomy. J Trauma 2001; 50: 650-654; discussion 654-656.
89. Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 1999; 46: 466-472.
90. Nordenholz KE, Rubin MA, Gularte GG, Liang HK. Ultrasound in the evaluation and management of blunt abdominal trauma. Ann Emerg Med 1997; 29: 357-366.
91. Blackbourne LH, Soffer D, McKenney M, Amortegui J, Schulman CI, Crookes B, Habib F, Benjamin R, Lopez PP, Namias N, Lynn M, Cohn SM. Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. J Trauma 2004; 57: 934-938.
92. Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998; 228: 557-567.
93. Chiu WC, Cushing BM, Rodriguez A, Ho SM, Mirvis SE, Shanmuganathan K, Stein M. Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma 1997; 42: 617-623; discussion 623-625.
94. Boulanger BR, Kearney PA, Tsuei B, Ochoa JB. The routine use of sonography in penetrating torso injury is beneficial. J Trauma 2001; 51: 320-325.
95. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma 2003; 54: 52-59; discussion 59-60.
96. Demetriades D, Velmahos G. Technology-driven triage of abdominal trauma: the emerging era of nonoperative management. Annu Rev Med 2003; 54: 1-15.
97. Ballard RB, Rozycki GS, Newman PG, Cubillos JE, Salomone JP, Ingram WL, Feliciano DV. An algorithm to reduce the incidence of false-negative FAST examinations in patients at high risk for occult injury. Focused Assessment for the Sonographic Examination of the Trauma patient. J Am Coll Surg 1999; 189: 145-150; discussion 150-151.
98. Stawicki SP. Trends in nonoperative management of traumatic injuries: A synopsis. OPUS 12 Scientist 2007; 1: 19-35.
99. Hayden GE, Everett W, Mark D, Fields J, Lee P, Dean AJ. The right intercostal window in bedside ultrasonography for IVC measurements is an alternative to traditional subxiphoid view. Ann Emerg Med 2007; 50: S67.
100. Hayden GE, Everett W, Mark D, Paszczuk A, Gracias VH, Kirkpatrick JN, Dean AJ. The right intercostal window for IVC measurement in critically ill patients is an alternative to subxiphoid views. Acad Emerg Med 2007; 14: S102.
101. Kazmers A, Groehn H, Meeker C. Duplex examination of the inferior vena cava. Am Surg 2000; 66: 986-989.
102. Hayden GE, Everett W, Mark D, Fields J, Lee P, Dean AJ. Transverse and longitudinal inferior vena cava measurements are equally accurate and useful. Ann Emerg Med 2007; 50: S68.
103. Ando Y, Yanagiba S, Asano Y. The inferior vena cava diameter as a marker of dry weight in chronic hemodialyzed patients. Artif Organs 1995; 19: 1237-1242.
104. Cheriex EC, Leunissen KM, Janssen JH, Mooy JM, van HooffJP. Echography of the inferior vena cava is a simple and reliable tool for estimation of 'dry weight' in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563-568.
105. Stawicki SP, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, Dean AJ. Intensivist use of hand-carried ultrasound to measure E/é and IVC collapsibility in estimating volume status: Correlations with pulmonary artery and central venous pressures. South Med J 2008; 101: 861.
106. Kusaba T, Yamaguchi K, Oda H. Echography of the inferior vena cava for estimating fluid removal from patients undergoing hemodialysis. Nippon Jinzo Gakkai Shi 1996; 38: 119-123.
107. Capomolla S, Febo O, Caporotondi A, Guazzotti G, Gnemmi M, Rossi A, Pinna G, Maestri R, Cobelli F. Non-invasive estimation of right atrial pressure by combined Doppler echocardiographic measurements of the inferior vena cava in patients with congestive heart failure. Ital Heart J 2000; 1: 684-690.
108. Patten RM, Mack LA, Wang KY, Lingel J. Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology 1992; 182: 201-204.
109. Grechenig W, Clement HG, Fellinger M, Seggl W. Scope and limitations of ultrasonography in the documentation of fractures-an experimental study. Arch Orthop Trauma Surg 1998; 117: 368-371.
110. Steiner GM, Sprigg A. The value of ultrasound in the assessment of bone. Br J Radiol 1992; 65: 589-593.
111. Noble VE, Legome E, Marshburn T. Long bone ultrasound: making the diagnosis in remote locations. J Trauma 2003; 54: 800.
112. Sempeles S. Pocket-size ultrasound device could speed access to images and information. J Clin Eng 2008; 33: 2-3.
113. Valentino M, Serra C, Zironi G, De Luca C, Pavlica P, Barozzi L. Blunt abdominal trauma: emergency contrastenhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 2006; 186: 1361-1367.